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Comment by scoofy | Hacker News Reader

There is a ton of ideology baked into naive-level analysis of this stuff.

I am constantly told how much less Europeans pay for better health outcomes and all I can think about was the obesity crisis I grew up around in Texas.

Socializing healthcare isn’t going to get an huge portion of the population out of their cars and get them walking as a primary or secondary mode of transportation. Not when it’s 100° and the grocery store is five miles away.

Americans, in no small part, have worse health outcomes because we have dramatically worse lifestyles. I support German-style universal healthcare, but I’m not going to pretend it will suddenly give us German health outcomes.

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>Socializing healthcare isn’t going to get an huge portion of the population out of their cars and get them walking as a primary or secondary mode of transportation

You would think so but once healthcare cost becomes a government policy issue people complain about its spending and they are forced to try and bring that cost down. One of the ways they did that in my country was to promote biking to work and build bike ways.

Did I mention the 100° summers or the fact that people usually live 20+ miles from where they work?

I agree with you generally on the incentives, but it took us 70 years to paint ourselves into this corner, and we’re not going to get out of it because of a third-order incentive.

Thats not every where nor is it everyone. Im not saying it will specifically be bikes but the government will be incentivized to have a healthier population. It could be higher tax on cigs, or sugars, it could be more annual leave it could be any number of wellbeing policies.

But it is many places. You can't just magically hand-wave away the fact that the demographics between these places are wildly different, and that changes the burdens on the systems in place.

From a political philosophy standpoint, this is exactly why many people oppose a single-payer healthcare system. When the government is paying for everything it creates a financial incentive for an intrusive nanny state. We can argue about the positives and negatives, and maybe we would be healthier overall, but many Americans simply don't want the government telling them what to do.

https://press.uchicago.edu/ucp/books/book/chicago/R/bo413854...

We are getting the "intrusive nanny state" regardless of financial incentives of a given healthcare system. That ship has sailed. It's a goal, not a side effect.

Europeans do pay much less (though: for roughly the same outcomes --- probably the same outcomes if you control for wild SES variance across the US).

Right… my exact point is that it’s not a like-for-like comparison.

Take Europeans, put them in Kansas. Fund their healthcare as though they were in Europe, and watch their health outcomes take a nosedive because the environment here is non-trivially worse for you health.

Unless I’m wildly misunderstanding these studies, it makes sense that we would need to spend more for the same outcomes because we are starting from a more unhealthy position, so the same results require more resources.

We need to at least be controlling for the 10%+ differences in obesity rates, and the enormous differences in UV index. That’s before even considering weekly exercise minimums that most European get when just walking to a bar.

I don't think there's a whole lot to understand in this study; it's pretty wildly extrapolated and its savings numbers come from spherical-cow projections of what single-payer would actually do (somehow, it would drastically cut pay to doctors without chasing them all out of the field).

I think the important bit in all these discussions is that "universal health care" and "single payer" aren't synonyms. Single payer is one way to do universal, and most universal systems don't do it. But this article conflates the two.

Then compare, say, Massachusetts to high functioning north Europe systems. You will shrink the lifestyle and climate factors down to a pretty minuscule difference, but you will still find that the spending is dramatically higher.

You're not wrong at all that the US has some systematic issues that place additional strain on the healthcare system, but it's a "yes and" situation here. Even accounting for those, we spend far, far too much because our system is extractive.

You could maybe compare the Boston metro. It should resemble a European city with satellite villages connected by trains.

I would be curious as to the costs/benefits there.

One wonders what the lowered stress vis a vis healthcare concerns that a reformed system would take care of would do for our ability, as an electorate, to make better decisions in other arenas.

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